Warning over statin use in HIV patients

29 November 2007

GPs may struggle to lower cholesterol in HIV patients because of a little-known interaction between simvastatin and anti-retroviral drugs, say sexual health experts.

In a letter to the journal Sexually Transmitted Infections, doctors from Chelsea and Westminster NHS Foundation Trust in London say they are seeing an increasing number of patients on protease inhibitors (PIs) being prescribed simvastatin, despite the two being contraindicated.

The problem is due to PIs blocking cytochrome p450, which metabolises simvastatin, reducing its effectiveness.

Low-dose atorvastatin and pravastatin are considered suitable alternatives in these cases. But the foundation trust has ‘seen a recent cluster of patients prescribed simvastatin whilst on PIs’ according to the letter.

This means HIV patients, who are known to have an increased risk of cardiovascular disease, fail to get their elevated cholesterol levels under control.